Barriers to adherence and hypertension control in a racially diverse representative sample of elderly primary care patients
Barriers to adherence and hypertension control in a racially diverse representative sample of elderly primary care patients
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DOI：
10.1002/pds.1766
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发表时间：
2009-08-01
影响因子：
2.6
通讯作者：
Roberts, Craig
中科院分区：
文献类型：
--
作者：
Turner, Barbara J.;Hollenbeak, Christopher;Roberts, Craig
目的：研究抗高血压药物依从性对不同种族老年患者血压的影响以及依从性的障碍。
方法：对来自四个城市初级医疗诊所的3416名70岁以上高血压患者中的300名代表性样本进行电话调查。通过电子病历，我们计算了受试者的年平均收缩压。我们询问了六个时间段内最后一次漏服抗高血压药物的情况。基于与血压控制的关联，不依从被定义为在过去3个月内漏服任何一次药物。受试者还被问及依从性障碍的六个方面：健康状况、个人支持、药物保险、药物领取和使用、医患互动以及知识。所有模型都根据人口统计学特征、治疗方案和抽样权重进行了调整。
结果：202名受试者（回复率为67%）情况如下：女性（65.9%），黑人（64.8%），平均年龄77.4岁（标准差5.49），平均服用2.4种（标准差1.3）抗高血压药物。不依从受试者（占队列的22%）的年平均收缩压高于依从受试者（137.7比133.4 mmHg，p = 0.065）。调整后，黑人患者中依从性与血压的关联比白人患者更强（p = 0.007）。在初始模型中，不知道医疗保险D部分的依从调整优势比（AOR）较低（p < 0.05）。在最终模型中，依从性障碍包括：药物领取/使用（药物用完[AOR 0.25，置信区间0.09 - 0.66]，八项障碍中的每一项都会使依从性降低28%）；医患互动（认为讨论高血压不太重要[AOR 0.32，置信区间0.12 - 0.84]）；以及知识（对于与高血压无关疾病的每个错误答案，AOR降低38%）。
结论：自我报告的依从性与较高的血压相关，尤其是在老年黑人患者中。为了提高依从性，我们的数据表明应针对以下方面：按处方取药、优先考虑高血压治疗以及进行高血压影响的教育。版权所有（C）2009约翰威立父子有限公司
Purpose To examine the effect of anti hypertensive adherence on blood pressure and barriers to adherence in racially diverse elderly patients.Methods Telephone survey of a representative sample of 300 of all 3416 hypertensive patients aged >70 from four urban primary care practices. From electronic records, we calculated subjects' annual mean systolic blood pressure. We asked about the last missed antihypertensive dose in six time intervals. Based on association with blood pressure control, non-adherence was defined as missing any dose in the past 3 months. Subjects were also asked about six domains of adherence barriers: health, personal support, drug coverage, medication filling and use, doctor-patient interaction and knowledge. All models adjust for demographics, treatment regimen and sampling weights.Results The 202 subjects (67% response rate) were: female (65.9%), black (64.8%), mean age 77.4 years (5.49) and on mean 2.4 (SD 1.3) antihypertensive drugs. Mean annual systolic pressure for non-adherent subjects (22% of the cohort) was higher than adherent subjects (137.7 vs.133.4 mmHg, p = 0.065). After adjustment, the association between adherence and blood pressure was stronger in black than white patients (p = 0.007). In an initial model, being unaware of Medicare Part D had a lower adjusted odds ratio (AOR) of adherence (p < 0.05). In the final model, adherence barriers were: medication filling/use (run out of pills [AOR 0.25, CI 0.09-0.66] and 28% reduction per each of eight barriers); doctor-patient interaction (less important to discuss hypertension [AOR 0.32, CI 0.12-0.84]); and knowledge (38% lower AOR per incorrect answer about diseases unrelated to hypertension).Conclusion Self-reported adherence was associated with a higher blood pressure, especially in elderly black patients. To promote adherence, our data suggest targeting: filling prescriptions, prioritizing hypertension care and educating about effects of hypertension. Copyright (C) 2009 John Wiley & Sons, Ltd.